Hospitals Still Handing Out Free Baby Formula

Action Points

Explain that fewer hospitals are packing infant formula in the diaper discharge bags sent home with new mothers, but most still do it despite criticism over the negative impact on breast feeding.

Note that the worst performing states, Maryland, Mississippi, South Dakota, and the District of Columbia, had no sample pack-free hospitals in 2010 in the survey.

Fewer hospitals are packing infant formula in the diaper discharge bags sent home with new mothers, but most still do it despite criticism over the negative impact on breast feeding, a study found.

The proportion that did not distribute formula in company-sponsored diaper bag sample packs doubled from 2007 to 2010 in the survey of more than 1,200 hospitals across 19 states and the District of Columbia with the highest and lowest rates.
But that represented an increase from only 14% to 28%, leaving most hospitals still on the side of distributing sample packs, Anne Merewood, PhD, MPH, a certified lactation consultant at Boston Medical Center, and colleagues reported in the October issue of Pediatrics.

At a press briefing around the release of that report, CDC director Thomas Frieden, MD, MPH, pointed out that hospitals may resist change for financial reasons.

In exchange for sending home formula samples, hospitals get free supplies needed for preemies and other special-needs infants who cannot breast feed, he explained.

The World Health Organization, CDC, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and the Government Accountability Office have all criticized this kind of hospital distribution of industry-sponsored formula packs.

Merewood's group had contacted all U.S. maternity hospitals regarding the practice in 2007 and followed up with hospitals in the 20 best and 20 worst states in 2010 to look for changes.

Top states for sample pack-free hospitals showed the greatest further gains as the numbers went from 25% in 2007 to 46% in 2010 (P<0.0001).

The bottom states showed slight improvement from less than 1% to 7% over the same span.

"This implies that patterns in pack removal may be influenced by 'peer pressure' or changing cultures at surrounding institutions, as sample pack-free institutions become more normal," the researchers suggested in the paper.

Any hospital that gave out industry-sponsored formula samples at discharge was considered not sample pack-free even if these were distributed only to formula-feeding women.

"This is based on our clinical knowledge that if industry-sponsored formula sample packs are present in the hospital, they are likely to be distributed to many women, not just to a particular group for whom they are theoretically designated," Merewood's group noted in the paper.

Across the states, Rhode Island came in with the highest proportion of sample pack-free hospitals at 86%.

At the bottom were Maryland, Mississippi, South Dakota, and the District of Columbia with no sample pack-free hospitals.

Hospital policy could be one contributor to breast feeding prevalence, the researchers speculated.

Using data from a CDC breastfeeding report for 2010, the 10 best states in Merewood's study had an average breast feeding initiation rate of 81.5% versus 67% in the 10 worst states.

The group cautioned, though, that they only considered distribution of sample packs within maternity services, which wouldn't have caught distribution from other areas of the hospital if maternity service staff weren't aware of it.

"One industry response to widespread efforts to change this practice has been to increase distribution of samples in other health care settings, for example, via the obstetrician's office, or direct to the home," they wrote.

Another limitation was the possibility that the 20 selected states weren't nationally representative, though other states likely fell between the two extremes studied, the investigators noted.

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